At our practice, we believe in Care Management
rather than Pain Management. That is why we
emphasize taking care of your teeth through regular re-care
visits and proper home-care. After all, you want to have
your teeth for a lifetime. Proper care of your teeth will
also help prevent costly treatment and procedures in the
long run.

What is Soft Tissue Management?
It is an individualized plan to eliminate infection of the
gums and root surfaces. Remember periodontal disease
is an infectious and inflammatory disease that results
from bacteria collecting on the tooth surface above and
below the gum line which destroys gum tissues and bone. The
greatest cause of adult tooth loss is gum disease.

Periodontal Disease

Scaling and Root-Planing
The procedure used is called Root-Planing. This
treatment is of the diseased root surfaces BELOW the
gum-line.

It focuses on eliminating:

Tartar and plaque below the gum

Detoxifying the root surfaces where the disease
occurs

Obtaining smooth roots

Flushing out the pockets allow for healthy
reattachment of the gums to the root surfaces.

The problem is due to multiple reasons, and hence the
treatment needs to be multi-faceted, addressing each of
these reasons.

The goals of this treatment are:

Gums that do not bleed. HEALTHY GUMS DO NOT
BLEED! Gums that are not red, swollen or tender

Fresher breath and taste

Reattachment of gum tissue to tooth surface

Smooth tooth surface

Flush out bacteria in pockets

Knowing how to effectively maintain good oral hygiene

Reduce pocket depths

Control periodontal disease

What we need from you, our patient to make this
treatment a success: :

Completion of the therapy as prescribed

Thoroughly cleaning all tooth
surfaces two times a day (See cleaning section below)

We will offer thorough instructions on home care to
insure the removal of bacteria on a daily basis. This
includes proper use of the toothbrush, paste, mouth
rinses, medications, floss threaders, and
proxy
brushes. Home care can effectively eliminate the
plaque above the gums and down to 2 mm below the gums.

How do I brush my teeth?

Place your toothbrush at a 45-degree angle against
the gums.

Move the brush back and forth gently in short
(tooth-wide) strokes.

Brush the outer tooth surfaces, the inner tooth
surfaces, and the chewing surfaces of the teeth.

Use the "toe" of the brush to clean the
inside surfaces of the front teeth, using a gentle
up-and-down stroke.

Brush your tongue to remove bacteria and freshen your
breath.

How do i floss my teeth?

Break off about 18 inches of floss and wind most of
it around one of your middle fingers. Wind the remaining
floss around the same finger of the opposite hand. This
finger will take up the floss as it becomes dirty. Hold
the floss tightly between your thumbs and forefingers.

Guide the floss between your teeth using a gentle
rubbing motion. Never snap the floss into the gums.

When the floss reaches the gum line, curve it into a
C shape against one tooth. Gently slide it into the
space between the gum and the tooth.

Hold the floss tightly against the tooth. Gently rub
the side of the tooth, moving the floss away from the
gum with up and down motions.

Crowns are dental restorations otherwise known as "caps"
which are coverings that fit over teeth. Crowns may be
necessary because of broken down old fillings, fractured,
chipped or sensitive teeth. Crowns are also used to improve
the appearance of natural teeth that are malformed,
mal-positioned or discolored.

Crowns are made of natural looking porcelain and are
made to improve your overall smile or to blend in with
your own teeth. Sometimes an underlying metal shell is
used under the porcelain if additional strength is needed.
A Bridge, as the name suggests, would be considered if you
would need multiple crowns across adjacent teeth. .

Some of the indications for a crown are:

A previously filled tooth where there now exists
more filling than tooth. The existing tooth structure
becomes weakened and can no longer support the filling.

Extensive damage by decay.

Discolorations and compromised esthetics.

Fractures

Root canal - After root canal, teeth tend to become
brittle and are more apt to fracture. These teeth need
to be protected by a crown. .

Bridges - When missing teeth are replaced with a
bridge, the adjacent teeth require crowns in order to
support the replacement teeth.

Crowns strengthen and protect the remaining tooth
structure and can improve the appearance of your teeth.
Crowns can be made from different materials which include
the full porcelain crown, the porcelain fused-to-metal crown
and the all-metal crown. You and Dr. Somani will decide
which type is appropriate, depending upon the strength
requirements and esthetic concerns of the tooth involved.

Fitting a crown requires at least two appointments.
During your first visit, the tooth is prepared for the
crown, an impression or mold is made of the tooth, and a
temporary crown is placed over the prepared tooth. At the
subsequent visit, the temporary crown is removed and the
final crown is fitted and adjusted and cemented into
place.

There are a couple of additional facts you should know
about regarding the care of your temporary crown:

Home care is extremely important while your temporary
crown is in place. The health of your gum tissue and the
success of your final treatment restoration depends upon
it. PLEASE do not be afraid to clean your teeth between
visits. With a minimal amount of home care, you should
be able to maintain the continued health of your teeth
and gum tissue during the time required to fabricate
your new crown.

Sometimes, even with meticulous care, temporary
crowns or bridges may become loose between visits. If
this should occur, please place the temporary crown or
bridge back on your tooth immediately. Putting a drop of
Vaseline in the temporary crown or bridge will
very often increase the retention and hold the temporary
in place until you can schedule an appointment. You can
also buy denttemp from drugstore and use it to
temporarily cement the temporary crown. Once again,
REPLACING THE TEMPORARY CROWN IMMEDIATELY IS VERY
IMPORTANT! It only takes a short time for teeth to move
if the temporary is not put back into its proper
position. This could affect the final restoration
significantly and may necessitate new impressions and a
great deal of time. If you can not replace the temporary
crown yourself, put it in a safe place and call the
office. We will be happy to recement it for you at the
earliest possible.

It is not unusual for the new crown to be mildly
sensitive to cold temperatures for a few weeks. However,
if the sensitivity is severe, does not subside, or if the
bite feels uncomfortable, contact us. Further adjustments
to the crown may be necessary.

If you have any questions regarding this or any other
procedure, please feel free to ask our staff, and we will
be happy to answer them.

Implants have undoubtedly become the
hottest new thing in dentistry. Dental implants are so
natural-looking and feeling, you may forget you ever lost a
tooth. You know that your confidence about your teeth
affects how you feel about yourself, both personally and
professionally. Perhaps you hide your smile because of
spaces from missing teeth. Maybe your dentures don't feel
secure. Perhaps you have difficulty chewing. If you are
missing one or more teeth and would like to smile, speak and
eat again with comfort and confidence, there is good
news! Dental implants are teeth that can look and feel
just like your own! Long-term studies continue to show
improving success rates for implants.

A dental implant is an artificial tooth root that is
placed into your jaw to hold a replacement tooth or
bridge. While high-tech in nature, dental implants are
actually more tooth-saving than traditional bridgework,
since implants do not rely on neighboring teeth for
support.

What Dental Implants Can Do?

Replace one or more teeth without affecting bordering
teeth.

Support a bridge and eliminate the need for a
removable partial denture.

Provide support for a denture, making it more secure
and comfortable.

Before dental
implant

After dental
implant

Advantages of Dental Implants Over Dentures or a
Bridge
Every way you look at it, dental implants are a better
solution to the problem of missing teeth. .

Esthetic Dental implants
look and feel like your own teeth! Since dental implants
integrate into the structure of your bone, they prevent the
bone loss and gum recession that often accompany bridgework
and dentures. No one will ever know that you have a
replacement tooth.

Tooth-saving Dental implants
don't sacrifice the quality of your adjacent teeth like a
bridge does because neighboring teeth are not altered to
support the implant. More of your own teeth are left
untouched, a significant long-term benefit to your oral
health!

Confidence Dental implants
will allow you to once again speak and eat with comfort
and confidence! They are secure and offer freedom from the
irksome clicks and wobbles of dentures. They'll allow you
to say goodbye to worries about misplaced dentures and
messy pastes and glues.

Reliable The success rate of
dental implants is highly predictable. They are considered
an excellent option for tooth replacement.

Are You a Candidate for Dental Implants?
The ideal candidate for a dental implant is in good general
and oral health. Adequate bone in your jaw is needed to
support the implant, and the best candidates have healthy
gum tissues that are free of periodontal disease.

What Can I Expect After Treatment?
As you know, your own teeth require conscientious at-home
oral care and regular dental visits. Dental implants are
like your own teeth and will require the same care. In
order to keep your implant clean and plaque-free, brushing
and flossing still apply! After treatment, we will work
closely with you to develop the best care plan for you.
Periodic follow-up visits will be scheduled to monitor
your implant, teeth and gums to make sure they are
healthy.

What is a Root Canal Treatment?
Root canal treatment, also known as endodontic treatment,
is a dental procedure in which the diseased or damaged pulp
(core) of a tooth is removed and the inside areas (the pulp
chamber and root canals) are filled and sealed.

Inflamed or infected pulp (pulpitis) most often causes a
toothache. To relieve the pain and prevent
further complications, the tooth may be extracted
(surgically removed) or saved by root canal treatment.
Root canal treatment has become a common dental procedure;
more than 14 million are performed every year, with a 95%
success rate, according to the American Association of
Endodontists.

Aftercare
The tooth may be sore for several days after filling. Pain
relievers, such as ibuprofen (Advil, Motrin) may be taken to
ease the soreness. The tissues around the tooth may also be
irritated. Rinsing the mouth with warm salt water several
times a day will help. Chewing on that side of the mouth
should be avoided for the first few days following
treatment. A follow-up appointment should be scheduled for
two weeks and then in six months after treatment to make
sure the tooth and surrounding structures are healthy.

Normal results
With successful root canal treatment, the tooth will no
longer cause pain. However, because it does not contain an
internal nerve, it no longer has sensitivity to hot, cold,
or sweets. These are signs of dental decay, so you must get
regular dental check-ups with periodic x-rays to avoid
further disease in the tooth. The restored tooth could last
a lifetime; however, with routine wear, the filling or crown
may eventually need to be replaced.

Oral Surgery or Tooth Extraction  Why do I
need it?
Tooth extraction is the removal of a tooth from its socket
in the bone. Extraction is performed for positional,
structural, or economic reasons. Teeth are often removed
because they are impacted. Teeth become impacted when they
are prevented from growing into their normal position in the
mouth by gum tissue, bone, or other teeth. Impaction is a
common reason for the extraction of wisdom teeth. Extraction
is the only known method that will prevent further problems.
Teeth may also be extracted to make more room in the mouth
prior to straightening the remaining teeth (orthodontic
treatment), or because they are so badly positioned that
straightening is impossible. Extraction may be used to
remove teeth that are so badly decayed or broken that they
cannot be restored. In addition, patients sometimes choose
extraction as a less expensive alternative to filling or
placing a crown on a severely decayed tooth. Wisdom tooth
extraction is generally needed if the tooth is extremely
hard to reach and maintain.

Things to know about
Potential complications of tooth extraction include
postoperative infection, temporary numbness from nerve
irritation, jaw fracture, and jaw joint pain. An additional
complication is called dry socket. When a blood clot does
not properly form in the empty tooth socket, the bone
beneath the socket is painfully exposed to air and food, and
the extraction site heals more slowly. .

Normal results
After an extraction, the wound usually closes in about two
weeks. It takes three to six months for the bone and soft
tissue to be restructured. Complications such as infection
or dry socket may prolong the healing time.

Why do you need Fillings?
Acid producing bacteria damage the enamel of your tooth.
This damaged portion of the tooth needs to be drilled out,
causing a cavity. Dental plaque provides a home for these
acid causing bacteria. That is why good oral hygiene is
extremely important for healthy teeth. (See our
Cleaning and Periodontal Disease section
above). Dental fillings are inserted as restorations
in the treatment of dental cavities, after drilling out the
cavities. However, once the infected hard tissues have been
removed, the resulting cavity preparation must be filled in
order to restore structural integrity to the tooth. This
will prevent further damage to the tooth and hopefully avoid
the eventual need for the tooth to be extracted.

Types of Fillings  It is your CHOICE!
Amalgam (silver filling)

Amalgam fillings are an alloy of mercury (from 43% to
54%) along with silver, tin, zinc and copper. Due to the
known toxicity of mercury, the main component of amalgam
fillings, there is an ongoing dental amalgam controversy
on the use of this filling material. (See
Dental
Amalgam Controversy)

Composite resin (white or plastic filling)

Composite resin fillings are a mixture of powdered glass
and plastic resin, and can be made to resemble the
appearance of the natural tooth. They are strong and
durable and cosmetically superior to silver or dark grey
colored amalgam fillings. Composite resin fillings are
usually more expensive than silver amalgam fillings.

Besides the aesthetic advantage of composite fillings
over amalgam fillings, the preparation of composite
fillings requires less removal of tooth structure to
achieve adequate strength. This is because composite
resins bind to enamel (and dentin too, although not as
well) via a micromechanical bond. As conservation of tooth
structure is a key ingredient in tooth preservation, Dr.
Somani prefers placing composite over amalgam fillings
when possible.

Things to know about
Fillings have a finite lifespan. Fillings fail because of
changes in the filling, tooth or the bond between them.
Amalgam fillings expand with age, possibly cracking the
tooth and requiring repair and filling replacement.
Composite fillings shrink with age and may pull away from
the tooth allowing leakage. As chewing applies considerable
pressure on the tooth, the filling may crack, allowing
seepage and eventual decay in the tooth underneath.

The tooth itself may be weakened by the filling and
crack under the pressure of chewing. That will require
further repairs to the tooth and replacement of the
filling. If fillings leak or the original bond is
inadequate, the bond may fail even if the filling and
tooth are otherwise unchanged

According to a recent study, the #1 question on peoples
mind when it comes to their teeth is teeth whitening!

How does it work?
Each of your teeth is made up of an inner dentin layer and
a hard outer enamel layer, which protects the teeth. When
you put stuff in your mouth -- food, cigarette smoke,
coffee, etc. -- another layer gradually forms on top of the
enamel layer. Basically, the foreign material accumulates to
form a pellicle film over the enamel layer. The problem is,
as this pellicle layer sits on your teeth for years and
years, the foreign material gets into the enamel. The deeper
stains are basically harmless, but many people find them
unattractive. This is where true tooth whiteners come in.
Basically, the whiteners use bleaching chemicals to get down
into the tooth enamel and set off a chemical reaction that
breaks apart the staining compounds. Most tooth whiteners
use one of two chemical agents: carbamide peroxide or
hydrogen peroxide.

Different type of Whitening
The three most common types of whitening to consider are
over-the-counter whitening, in-home whitening with
customized trays and whitening material, and the in-office
whitening. And as you can guess, each of the above
system has progressively faster results. The in-office
whitening gives you a brighter, whiter smile in just under
an hour, and you could have a smile that is at least 4 to 6
shades lighter! (Results may vary based on individual
conditions)

Some sensitivity may develop after the process, but is
should subside after a few days. Ask Dr. Somani which
is the right procedure for you!

Veneers are a thin, semi-transparent tooth shaped "shell"
that are made of porcelain. They are permanently
bonded to your natural teeth which are located in your "smile
zone" to enhance their shape, color, length or size.
They fit your teeth precisely to look completely natural.
They are used to conceal damaged, stained or misshaped
surfaces of your teeth.

The great thing about veneers is they allow a
conservative approach to long-lasting, major
cosmetic changes.

The benefits of veneers as an alternative to a
white fillings or crowns is:

Only a small amount of the tooth structure (enamel)
is removed (if any) during the procedure.

They can mask undesirable defects such as
tetracycline stains, an injury or discolored fillings.

Often no anesthesia is needed.

It gives a natural appearance with little to no
discomfort.

They are often a less costly alternative procedure to
having crowns.

Porcelain veneers are durable, strong, stain
resistant and beautiful.

Braces vs. Veneers
Veneers are usually more expensive than braces, but the
results are immediate. Veneers can improve the appearance of
an overbite or underbite but NOT correct it. Braces
can realign the jaw and correct overbites and underbites,
but they take time. Veneers cost a lot less than
braces.

Durability
Veneers can last for years depending on how well you
take care of them.Their durability will be
shortened if you use them to bite your nails, open objects
with them, or chew on hard things like ice.
Veneers can also chip or peel if not cared for properly, To
ensure they will last for years you need to maintain good
oral health hygiene and regular dental cleanings and exams
twice a year. Aftercare
Care tips of your cosmetic restorations:

For about two weeks you will go through an adjustment
period as you "get use to" your "new"
teeth that have been changed in size and shape. It will
take your brain some time to recognize the new position
of your teeth or their new thickness as normal. If you
detect any high spots or problems with your bite call
us.

Veneers have great crushing strength but not "tensile
strength". Avoid anything that will twist the
veneer. Please avoid the following things would
break even natural teeth such as chew on pistachio
nuts, hard candy, chicken or rib bones, jelly apples or
open things with your teeth.

As with your natural teeth, veneers require good oral
hygiene. Brush with a ultra-soft toothbrush. Try a
electric
toothbrush for better cleaning. Do not use a
sonic type toothbrush as the vibrations may loosen the
restoration.

Use non-abrasive toothpaste or toothpaste with baking
soda. Avoid "extra whitening" toothpaste
because they are often very abrasive and can scratch
your restoration.

Floss between all teeth at least once a day to remove
plaque. Flossing before bedtime is the best time.

Clean around your gum line carefully.

Your gums may be sore, try rinsing them with water
salt water (1 tsp. salt in 8 of warm water,
rinse-swish-spit 3 times a day) for several days to
reduce swelling and discomfort.

Eat a normal diet yet be careful when eating hard
foods, they can damage veneers.

Do not rinse routinely with mouthwashes, as they are
high in alcohol. Alcohol softens bonding and
weakens the bond of porcelain. If mouthwash is
desired, a solution of hydrogen peroxide and water could
be used or select a non-alcohol containing mouthwash.

Dr. Somani will see you for professional maintenance,
cleaning and polishing of your restorations every six
months. ALWAYS tell the staff you have porcelain veneers
when you have your teeth cleaned and make sure they use
a neutral sodium fluoride. Stannous fluoride or
acidulated phosphate fluoride are not recommended for
composite resin bonding or porcelain.

DO NOT:

Brush with a medium or hard toothbrush with an
abrasive paste...it can scratch your restorations.

Don't brush your teeth hard.

Do not use stannous fluoride or Acidulated Phosphate
Fluoride products with your veneers. They can etch
the porcelain veneers and decrease the surface
smoothness of your veneer.

Smoke, it will stain your restoration. Not
smoking will increase the life span of you and your
restorations.

Avoid chewing tobacco, it will stain the veneers.

Like natural teeth, the bonded material can pick up
stains: try to avoid or keep to a minimum tobacco,
coffee, tea, soy sauce, curry, colas, grape juice,
blueberries or red wine or indulge in foods or drinks
that have dark pigments because they can stain your
veneers.

If you feel a rough edge do NOT pick at it, make an
appointment with use to have it smoothened.

Allow anyone to clean your restorations with
ultrasonic tools, air polishers or abrasive polishing
pastes. Only composite or diamond polishing paste
is to be used for your professional cleanings.

Like any restoration, it is possible for the veneer
to come off or for small decay to develop. In that
situation a new veneer may be required. Also replacement
of the restorations may be required in several years.

Invisalign is the easy way to improve your smile. It
is proven technology designed to give you the smile you've
always wanted, without the pain and anxiety associated with
metal braces.

How does it work?
To help you get a more beautiful smile, we use a series
of clear, removable aligners to gradually move your teeth.
You wear a set of aligners for about two weeks, removing
them only to eat, drink, brush and floss. As you replace
each set of aligners with the next in the series, your
teeth will gradually move until they reach the position
Dr. Somani has prescribed for you. To learn more,
take
a look at this video on the Invisalign website.

The clear alternative to metal braces.
By using a series of clear, removable aligners, Invisalign
straightens your teeth with results you'll notice sooner
than you think. The course of treatment involves changing
aligners approximately every two weeks, moving your teeth
into straighter position step by step, until you have a more
beautiful smile. And unlike braces, these clear aligners can
be removed while you eat and brush your teeth as usual.

Since Invisalign is practically invisible, there's no
unwarranted attention to your mouth. In fact, very few
people will notice at all - unless you tell them. They're
comfortable to wear and remove easily when you eat, brush,
and floss.

Less treatment time
An average Invisalign course of treatment takes about a
year. You'll see Dr. Somani every 6 to 8 weeks for
adjustments and to check progress. At regular intervals,
you'll receive a new set of custom-molded clear aligners to
continue the straightening process. The total number of
clear aligners is specific to you, determined by Dr. Somani
for your course of treatment.

All across the country, people like you now have
great smiles and straighter teeth, thanks to Invisalign.
Why not join them? That gorgeous smile you want is just a
click away.

Dentures are replacements for missing teeth that can
be taken out and put back into your mouth. While dentures
take some getting used to, and will never feel exactly the
same as one's natural teeth, today's dentures are natural
looking and more comfortable than ever.

There are two main types of dentures: full and partial.
Dr. Somani will help you choose the type of denture that's
best for you based on whether some or all of your teeth
are going to be replaced and the cost involved.

How do Dentures Work?
With full dentures, a flesh-colored acrylic base fits
over your gums. The base of the upper denture covers the
palate (the roof of your mouth), while that of the lower
denture is shaped like a horseshoe to accommodate your
tongue. Dentures are custom-made in a dental laboratory
from impressions taken of your mouth. Dr. Somani will
determine which type of denture is best for you.

Full Denture
A conventional full denture is placed in your mouth after
any remaining teeth are removed and tissues have healed.
Healing may take several months, during which time you are
without teeth. An immediate full denture is inserted
immediately after the remaining teeth are removed. Dr.
Somani takes measurements and makes models of your jaw
during a prior visit. While immediate dentures offer the
benefit of never having to be without your teeth, they
must be relined several months after being inserted. The
reason is that the bone supporting the teeth reshapes as
it heals, causing the denture to become loose.

Partial Denture
A partial denture rests on a metal framework that
attaches to your natural teeth. Sometimes crowns are
placed on some of your natural teeth and serve as anchors
for the denture. Partial dentures offer a removable
alternative to bridges.

How Long Before I Get Used to My Dentures?
New dentures may feel awkward or uncomfortable for the
first few weeks or even months. Eating and speaking with
dentures might take a little practice. A bulky or loose
feeling is not uncommon, while the muscles of your cheeks
and tongue learn to hold your dentures in place. Excessive
saliva flow, a feeling that the tongue does not have
adequate room, and minor irritation or soreness are also
not unusual. If you experience irritation, call our
office.

How long do Dentures Last?
Over a period of time, your denture will need to be
relined, remade, or rebased due to normal wear. Rebasing
means making a new base while keeping the existing denture
teeth. Also, as you age, your mouth naturally changes.
These changes cause your dentures to loosen, making
chewing difficult and irritating your gums. At a minimum,
you should see Dr. Somani annually for a checkup.

Tips for Denture Care

When handling your dentures, stand over a folded
towel or basin of water. Dentures are delicate and may
break if dropped.

Don't let your dentures dry out. Place them in a
denture cleanser soaking solution or in plain water when
you're not wearing them. Never use hot water, which can
cause them to warp.

Brushing your dentures daily will remove food
deposits and
plaque,
and help prevent them from becoming stained. An
ultrasonic cleaner may be used to care for your
dentures, but it does not replace a thorough daily
brushing.

Brush your gums, tongue and palate every morning with
a soft-bristled brush before you insert your dentures.
This stimulates circulation in your tissues and helps
remove plaque.

See Dr. Somani if your dentures break, chip, crack or
become loose. Don't be tempted to adjust them yourself 
this can damage them beyond repair.